What is spinal degeneration and degenerative disc disease?

The spinal column is made up of bones call vertebra, each of which has a center canal that when stack up on top of each other formulate the central canal and house the spinal cord. Each vertebrae are stacked on facet joints and the disc. When the vertebrae are in lined, they also create a lateral canal for the exiting nerve roots as they branch off of the spinal cord.

 

What are the common cause of degenerative disc disease?

Over time, wear and tear to the discs, joints and bones can occur resulting in degenerative changes to the spine. These degenerative changes may include decreased disc height, loss of joint cartilage, bony spurring (osteophytes) and thickening of bone. This condition is known as spinal degeneration. As this condition progress the spinal canal and intervertebral foramen can begin to narrow and may eventually place pressure on the spinal cord and nerves resulting in a variety of symptoms. DDD is also called back arthritis, osteoarthritis of the spine, spinal arthritis, disc degeneration, and spinal stenosis. It is typically the later stages of the more acute type of back injuries and tends to occur in older patients.

   

What are the symptoms of degenerative disc disease?

Patients with this condition generally experience an increase in symptoms during activities that repetitively or continuously straighten or extend the spine.  Symptoms may also increase during activities that place weight on the spine (e.g. lifting, prolonged standing, walking etc). Symptoms tend to ease during activities that bend the spine (e.g. sitting) or take weight off it (e.g. lying). Often the symptoms are both flexion and extension in nature and this characteristic finding makes activity challenging.

 

What is the prognosis of DDD

Despite appropriate physiotherapy management, some patients with spinal degeneration continue to deteriorate. When this occurs, other intervention may be required. This may include pharmaceutical intervention, corticosteroid injection, the use of supplements such as glucosamine and chondroitin, investigations such as an X-ray, CT scan, bone scan or MRI, or assessment from a specialist. The treating physiotherapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically. In more severe cases of spinal degeneration involving spinal canal stenosis or nerve compression, surgery may be required to relieve the pressure on the spinal cord or nerves.

   

When should you seek emergency medical attention for DDD?

  • Worsening symptoms. Pain, numbness or weakness may increase to the point that you can't perform your usual daily activities.
  • Bladder or bowel dysfunction. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.
  • Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.
   

How can physiotherapy and massage therapy help DDD of the neck and/or back?

DDD of the cervical spine describes a narrowing of the mid and lower cervical disc spaces, which causes the articular surfaces (facet joints) to approximate each other. This leads to compression of the joints, decreased mobility, and eventual compression of the nerve roots as they exit the spine. Typically, people present in our office with limited extension, side flexion, and rotation and an inability to move their neck. In severe cased, there may be a neurological component and nerve compression causing arm symptoms. Manual therapy is focused on the neck and upper back (thoracic) joints to improve function and range of motion. Depending on the degree of degenerative change and nerve compression, we gently decompress (i.e. traction) and mobilize the degenerative joints, while also paying close attention to restoring normal mobility in the healthy joints around the region. In addition, we perform soft tissue release to the shortened musculature of the neck to ensure they are not responsible for losses in range of motion after the joint mobility has improved.

  Lumbar spinal stenosis is a disease caused by arthritic changes to the vertebral joints of the lower back and can lead to low back pain and intermittent claudication in one or both legs (characterized by leg numbness, pain and weakness). The region where the nerves exit the spine becomes impinged due to the combination of decreased disc height and the presence of osteophytes (i.e. bony spurs). Typically, people present with symptoms when walking and standing, but are relieved by sitting. Our manual therapy treatments focus on: sustained repetitions of lumbar spine traction to decompress the nerves and reduce pain, joint mobilization to improve overall spinal mobility in the area to decrease stress on the affected joints, and soft tissue release of the hip/pelvis to increase mobility. This will allow the patient to better perform pain-relieving exercises at home. Our goals are to improve one's walking endurance and decrease nerve pain.

  Physiotherapy treatment for patients with spinal degeneration is important to assist with pain relief, improve flexibility and strength, and to ensure an optimal outcome. This may comprise:

  • soft tissue massage
  • laser therapy
  • mobilization
  • traction
  • ice or heat treatment
  • education
  • activity modification advice
  • prescription of walking aids
  • hydrotherapy
  • exercises to improve flexibility, strength and core stability
   

Massage Therapy

The goals of the Massage Therapist is to decrease compression on the disc and nerves as well as reducing pain and spasm, hypertonicity (tight muscles) and trigger points. Treatment by the Massage Therapist consists of myofascial release and Swedish massage techniques to treat the trigger points and hypertonicity of the affected muscles. In the cervical spine they consist of the suboccipital and posterior neck, shoulder muscles and erector spinae (muscles that attach to the spine). For the lumbar spine these muscles consist of hip flexors, ITB, quadriceps, quadratus lumborum and possibly hamstrings, tensor fascia lata and calves.  

How can exercise and physical development help degenerative disc disease?

Rehabilitation with DDD

We begin with a thorough clinical musculoskeletal and functional assessment, and combined with appropriate investigations, a diagnosis of spinal degeneration can be made. An X-ray of the spine will typically demonstrate changes associated with degeneration. Other investigations such as CT scan, bone scan or MRI may also be indicated to assess the severity and to determine the exact structures that are affected.

  Patients with this condition are generally managed well with an appropriate physiotherapy program. Whilst little can be done to reverse the changes to the spine, patients can generally remain active by modifying their activities appropriately. The primary goal of treatment is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. This can be achieved by having regular breaks from levels of activity that increase symptoms (e.g. excessive walking, standing, lifting) with positions of comfort (e.g. sitting or lying). Activities should be balanced ideally to prevent any increase in symptoms. A gradual increase in activity and exercise can occur as guided by the treating physiotherapist provided symptoms do not increase.

  Alternative exercises placing minimal force through the spine should be performed to maintain fitness provided they do not increase symptoms. Better activities include cycling on a stationary bike and hydrotherapy exercises designed by a physiotherapist. Patients should also perform flexibility, strengthening and core stability exercises to ensure an optimal outcome. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.

  A preventative program of manual therapy that is focused on maintaining spinal mobility and spinal health, and this, along with good postural habits and a balance of flexion and extension movements will also greatly reduce reoccurrence. Lifestyle change is the most critical factor in reducing the risk of re injury. Herniated discs occur in the fittest athletes, Olympians suffer from this problem even though they are very fit. Why? Because even fit individuals can have a weak trunk and core and can spend too much time sitting, bending, lifting and basically overusing their backs.

   

Physiotherapy and Physical Development

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your injuries, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home
   

How can low intensity laser therapy help Degenerative Disc Disease (DDD)?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.

  The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.

  Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.

  The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.

   

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated.

  The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.    

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